American Indian Health Provider Resources


FAQs for the American Indian Health Program and ALTCS FFS

What is the American Indian Health Program (AIHP)?
The AHCCCS Acute Fee For Service Program for American Indians, administered by the State through the Division of Fee For Service Management at AHCCCS.

Who can treat AIHP members?
Any AHCCCS Registered Provider that has not opted out of fee for service.  The AHCCCS FFS Program does not contract with individual providers.

How do you submit a claim for an American Indian?

If member is enrolled in AIHP and you are an AHCCCS FFS Provider (any AHCCCS Registered Provider that has not opted out of fee for service). Claims are submitted to AHCCCS/Division of Fee For Service Management (DFSM).
If member is enrolled with managed care or a program contractor and services are NOT provided at an IHS/Tribal 638 facility. Claims are submitted directly to the plan / program contractor.
If member is enrolled with managed care or a program contractor and services ARE provided at an IHS/Tribal 638 facility. Claims are submitted to AHCCCS/DFSM.
If member is receiving Behavioral Health services at an IHS/Tribal 638 facility. Claims are submitted to AHCCCS/DFSM.
If member’s Behavioral Health Services are NOT provided at an IHS/Tribal638 facility. Claims are submitted to the member’s RBHA or TRBHA.
If member receives Transportation and Case Management services for Behavioral Health, regardless of where the services were received. Claims are submitted to the member’s RBHA or TRBHA.

 

Please use this link to submit your AHCCCS/DFSM claims online.
https://azweb.statemedicaid.us/Home.asp


What about Referral Services?
AIHP members do not need referrals to see an AHCCCS registered provider.  For more details:
http://www.azahcccs.gov/commercial/Downloads/ClaimsClues/2009/ClaimsClues_Jan09.pdf


Which services need PA requirements for AIHP members?
Please use these links to Chapter 820 in the AMPM; Chapter 6 in the IHS/638 Provider Billing Manual; and Chapter 8 in the FFS Provider Manual.
http://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/Chap800.pdf
http://www.azahcccs.gov/commercial/Downloads/IHS-TribalManual/IHS-Chap06PA-IHSRef.pdf
http://www.azahcccs.gov/commercial/Downloads/FFSProviderManual/
FFS_Chap08PriorAuthorizations.pdf


Can an American Indian switch from a health plan to FFS and back again?
Yes. Under federal law, American Indians may not be required to choose a managed care plan.  Please use this link to sign in and verify eligibility online at the time of service. https://azweb.statemedicaid.us/Home.asp


What are the FFS Programs?
AIHP, FES (Federal Emergency Services), Tribal ALTCS (including Gila River Indian Community, Hopi Tribe, Navajo Nation, Pascua Yaqui Tribe, San Carlos Apache Tribe, Tohono O’Odham Nation, White Mountain Apache Tribe, and Native American Community Health), and QMB Only.  A QMB Only is a Non-AHCCCS Member who retains original Medicare coverage and has no AHCCCS health plan enrollment.  The member opts out of “QMB Dual” coverage, and AHCCCS pays for coinsurance and deductible for Medicare. 
Please use this link for information on ALTCS Tribal Case Management. http://www.azahcccs.gov/tribal/providers/tribalALTCS.aspx


Where do you go for answers to further questions regarding AIHP eligibility, coverage, and provider billing rates?
The AHCCCS Website/AIHP Portal
http://www.azahcccs.gov/tribal/default.aspx

The IHS/Tribal Provider Billing Manual
http://www.azahcccs.gov/commercial/ProviderBilling/manuals/IHSTribalBillingManual.aspx

AHCCCS Medical Policy Manual (AMPM)
http://www.azahcccs.gov/shared/MedicalPolicyManual/MedicalPolicyManual.aspx?ID=providermanuals

FFS Provider Manual
http://www.azahcccs.gov/commercial/ProviderBilling/manuals/FFSProviderManual.aspx

Provider Billing Rates
http://www.azahcccs.gov/commercial/ProviderBilling/rates/rates.aspx

Behavioral Health Services Guide
http://www.azahcccs.gov/commercial/shared/BehavioralHealthServicesGuide.aspx?ID=providermanuals


If you have further questions, you may call AHCCCS Provider Services at (602) 417-7670 for specific billing and eligibility questions.